chapter 24 prepu

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: "Have you tried to quit smoking before?" "Nicotine patches would be appropriate for you." "Many options are available for you." "I can refer you to the American Lung Association."

"Have you tried to quit smoking before?"

A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? "After I breathe in, I will hold my breath for 10 seconds." "If I use the spacer, I know I am only supposed to push on the inhaler once." "I will make sure to take a slow, deep breath as I push on my inhaler." "I do not need to rinse my mouth with this type of inhaler."

"I do not need to rinse my mouth with this type of inhaler."

The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent? 30% 70% 50% 90%

90%

A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema: Decreased sputum production with dilation of bronchioles Increased oxygen diffusion with inflammation of the bronchioles An abnormal distention of the air spaces with destruction of the alveolar walls Inflammation of the bronchioles with a normal distention of the air spaces

An abnormal distention of the air spaces with destruction of the alveolar walls Emphysema is a pathologic term that describes an abnormal distention of the air spaces beyond the terminal bronchioles and destruction of the walls of the aveoli. This causes a decrease in oxygen diffusion and an increase in sputum production.

Which of the following is a symptom diagnostic of emphysema? Copious sputum production Dyspnea Normal elastic recoil The occurrence of cor pulmonale

Dyspnea Dyspnea is characteristic of emphysema. A chronic cough is considered the primary symptom of chronic bronchitis. Refer to Table 11-1 in the text.

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client Records in a diary the number achieved after one breath Inhales deeply and holds the breath Sits in a straight-back chair and leans forward Exhales hard and fast with a single blow

Exhales hard and fast with a single blow

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client Has wheezes in the right lung lobes Cannot perform activities of daily living Has a respiratory rate of 28 breaths/minute Reports shortness of breath

Has wheezes in the right lung lobes

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in? IV III II I

II All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%

Asthma is cause by which type of response? IgA-mediated IgD-mediated IgE-mediated IgM-mediated

IgE-mediated

Which of the following measures may increase complications for a patient with COPD? Administration of antitussive agents Increased oxygen supply Administration of antibiotics Decreased oxygen supply

Increased oxygen supply Administering too much oxygen can result in the retention of carbon dioxide. Patients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and increasing hypercapnia occurs. All the other measures are aimed at preventing complications.

The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) Overinflated alveoli impair gas exchange. Dry airways obstruct airflow. Inflamed airways obstruct airflow. Mucus secretions block airways.

Inflamed airways obstruct airflow. Mucus secretions block airways. Overinflated alveoli impair gas exchange.

Which of the following medications are contraindicated in acute asthma exacerbations? Proventil Xopenex Atrovent Intal

Intal

A nursing student just learned that the primary presenting symptom of emphysema is dyspnea. During the clinical rotation that same week, the student is assigned to a patient diagnosed with emphysema. In prioritizing the care for the shift, the student would choose which of the following interventions first? Refer to respiratory therapy if labored breathing persists. Apply oxygen therapy as ordered. Monitor vital signs every 2 hours, including respiratory rate and characteristics. Educate regarding smoking cessation.

Monitor vital signs every 2 hours, including respiratory rate and characteristics.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? Avoiding the use of oxygen to decrease the hypoxic drive Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Providing sufficient oxygen to improve oxygenation Increasing pH

Providing sufficient oxygen to improve oxygenation

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Respiratory acidosis Metabolic alkalosis Respiratory alkalosis Metabolic acidosis

Respiratory acidosis In status asthmaticus, increasing PaCO2 (to normal levels or levels indicating respiratory acidosis) is a danger sign signifying impending respiratory failure. Understanding the sequence of the pathophysiologic processes in status asthmaticus is important for understanding assessment findings. Respiratory alkalosis occurs initially because the patient hyperventilates and PaCO2 decreases. As the condition continues, air becomes trapped in the narrowed airways and carbon dioxide is retained, leading to respiratory acidosis.

A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. Status asthmaticus Respiratory failure Atelectasis Pertussis Thoracentesis

Status asthmaticus Respiratory failure Atelectasis

A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed? Three times a day regardless of meal time Before meals After meals and at bedtime With meals

With meals

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: instruct the client to drink at least 2 L of fluid daily. administer anxiolytics, as ordered, to control anxiety. maintain the client on bed rest. administer pain medication as ordered.

instruct the client to drink at least 2 L of fluid daily. Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.

The classification of Stage II of COPD is defined as severe COPD. at risk for COPD. ery severe COPD. moderate COPD. mild COPD.

moderate COPD.

The classification of Stage IV of COPD is defined as very severe COPD. moderate COPD. severe COPD. mild COPD. at risk for COPD.

very severe COPD. Stage IV is very severe COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage II is moderate COPD. Stage III is severe COPD.

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first: Collects sputum for culture and sensitivity Provides nebulized tobramycin (TOBI) Administers vancomycin intravenously Gives oral pancreatic enzymes with meals

Collects sputum for culture and sensitivity Aggressive therapy for cystic fibrosis involves airway clearance and antibiotics, such as vancomycin and tobramycin, which will be prescribed based on sputum cultures. Sputum must be obtained prior to antibiotic therapy so results will not be skewed. Administering oral pancreatic enzymes with meals will be a lesser priority.

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. Mucus secretions that block airways Overinflated alveoli that impair gas exchange Inflamed airways that obstruct airflow Decreased numbers of goblet cells Dry airways that obstruct airflow

Mucus secretions that block airways Overinflated alveoli that impair gas exchange Inflamed airways that obstruct airflow

The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack? Preparing a written action plan Staying in the house if it is too cold or too hot Avoiding exercise and any strenuous activity Using a long-acting steroid inhaler when an attack is coming

Preparing a written action plan

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? Flovent Proventil Atrovent Combivent

Proventil

The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? Metabolic acidosis Metabolic alkalosis Respiratory alkalosis Respiratory acidosis

Respiratory alkalosis Respiratory alkalosis (low PaCO2) is the most common finding in patients with an ongoing asthma exacerbation and is due to hyperventilation.

Question 4 of 10 A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu-Medrol) intravenously. The nurse: Aspirates for blood return before injecting the medication Informs the client to limit fluid intake due to fluid retention Assesses fasting blood glucose levels Encourages the client to decrease caloric intake due to increased appetite

Assesses fasting blood glucose levels Adverse effects of methylprednisolone include abnormalities in glucose metabolism. The nurse monitors blood glucose levels. Methylprednisolone also increases the client's appetite and fluid retention, but the client will not decrease caloric or fluid intake as a result of these adverse effects. It is not necessary to aspirate for blood return prior to injecting the medication, because doing so would not support the intravenous line in the vein.

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: atelectasis. pulmonary edema. oxygen toxicity. pleural effusion.

atelectasis. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

A physician orders triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs? Administer the triamcinolone and then administer the salmeterol. Monitor the client's theophylline level before administering the medications. Administer the salmeterol and then administer the triamcinolone. Allow the client to choose the order in which the drugs are administered.

Administer the triamcinolone and then administer the salmeterol. A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone is a corticosteroid; Salmeterol is an adrenergic stimulant (bronchodilator). If the client is ordered a bronchodilator and another inhaled medication, the bronchodilator should be administered first to dilate the airways and to enhance the effectiveness of the second medication. The client may not choose the order in which these drugs are administered because they must be administered in a particular order. Monitoring the client's theophylline level isn't necessary before administering these drugs because neither drug contains theophylline.